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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Cardiac Rehabilitation Program-Related Factors Associated With Morbidity Among Patients in Low-Resource Settings:
Sana A Elashie1, Sherry L Grace, Farzana A Hashmi
1Author Affiliations: Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar (Ms Elashie and Dr Turk-Adawi); Faculty of Health, School of Kinesiology and Health Science, York University, Toronto, Canada (Drs Grace and Ghisi); KITE - Toronto Rehabilitation Institute and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada (Drs Grace and Ghisi); Preventive Cardiology and Rehabilitation, Tabba Heart Institute, Karachi, Pakistan (Dr Hashmi); Department of Rehabilitation Medicine, Cardiac Rehabilitation Program, Sarawak Heart Center, Kota Samarahan, Sarawak, Malaysia (Dr Kim); Department of Cardiology, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran (Dr Sadeghi); Servicio de Rehabilitacíon Cardiaca, Departamento de Cardiocirugía, Centro Médico Nacional, Mexico City, Ciudad de México, Mexico (Dr Vargas); Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherland (Dr Heine); Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar (Dr Al Shamari); and Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile (Ms Sepulveda).
Insights
Cardiac rehabilitation (CR) programs in low-resource settings can reduce patient morbidity. Key factors include comprehensive risk assessment and robust CR healthcare teams.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Services Research
Background:
- Cardiovascular disease (CVD) is a major global health burden, especially in low-resource settings.
- Cardiac rehabilitation (CR) is proven effective, but its implementation varies significantly in resource-limited environments.
- Understanding program characteristics is crucial for optimizing CR outcomes in these specific contexts.
Purpose of the Study:
- To identify specific characteristics of cardiac rehabilitation (CR) programs in low-resource settings that are associated with reduced all-cause morbidity among participants.
- To provide evidence-based recommendations for improving CR effectiveness in diverse global healthcare environments.
Main Methods:
- A prospective observational study utilizing data from the International CR Registry.
- Analysis of program characteristics and patient morbidity (hospitalization, emergency visits, CVD events) one year post-assessment.
- Multilevel modified Poisson regression was employed to account for patient clustering within CR programs.
Main Results:
- A lower incidence of morbidity was linked to programs assessing more risk factors (IRR=0.55).
- Increased numbers of CR healthcare professionals were associated with reduced morbidity (IRR=0.76).
- CR programs situated in academic/tertiary care institutions showed significantly lower morbidity rates (IRR=0.61).
Conclusions:
- Prioritizing comprehensive risk assessment within CR programs is essential.
- Strengthening CR healthcare teams can lead to improved patient outcomes and reduced morbidity.
- These findings offer actionable insights for enhancing CR effectiveness globally, particularly in resource-constrained regions.
Purpose:
Cardiovascular disease is a leading cause of morbidity globally, particularly in low-resource settings. The effectiveness of cardiac rehabilitation (CR) is well-established; however, the nature of services in low-resource settings differs. This study sought to investigate program characteristics associated with lower all-cause morbidity among CR participants from low-resource settings.
Methods:
This was a prospective observational study analyzing the International Council of Cardiovascular Prevention and Rehabilitation's International CR Registry. Programs with annual assessment data at the time of study were included, and their characteristics were assessed in a survey. Self and program-reported patient morbidity included all- and cardiac-cause hospitalization, emergency department visits, cardiovascular disease events, and procedures 1 year from initial assessment. A multilevel modified Poisson regression model was used to account for clustering of patients within CR programs, estimating the adjusted incidence rate ratios (IRR) for morbidity.
Results:
Of the 690 patients from programs in 6 countries across 4 regions (Colombia, Iran, Malaysia, Mexico, Pakistan, and Qatar), 637 (92%) were retained, of which 479 (75%) had morbidity data. Seven patients died and 93 suffered morbidity; this was most commonly noncardiac hospitalization (29 events) and emergency department visits (18 events). The regression analysis revealed a significantly lower incidence of morbidity associated with the following program factors: higher number of risk factors assessed (IRR = 0.55: 95% CI, 0.39-0.77), greater number of CR health care professionals (IRR = 0.76: 95% CI, 0.65-0.89), and CR located in academic/tertiary care institution (IRR = 0.61: 95% CI, 0.50-0.75).
Conclusion:
Globally, CR programs could benefit from prioritizing comprehensive risk assessment and strengthening CR teams to potentially reduce morbidity.
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